Patient Education Issues and Strategies Associated With Immunotherapy

Potential role of immunotherapy and targeted therapy in the treatment of cancer: A contemporary nursing practice

Immunotherapy and targeted therapy have emerged as promising therapeutic options for cancer patients. Immunotherapies induce a host immune response that mediates long-lived tumor destruction, while targeted therapies suppress molecular mechanisms that are important for tumor maintenance and growth. In addition, cytotoxic agents and targeted therapies regulate immune responses, which increases the chances that these therapeutic approaches may be efficiently combined with immunotherapy to ameliorate clinical outcomes. Various studies have suggested that combinations of therapies that target different stages of anti-tumor immunity may be synergistic, which can lead to potent and more prolonged responses that can achieve long-lasting tumor destruction. Nurses associated with cancer patients should have a better understanding of the immunotherapies and targeted therapies, such as their efficacy profiles, mechanisms of action, as well as management and prophylaxis of adverse events. Indeed, this knowledge will be important in establishing care for cancer patients receiving immunotherapies and targeted therapies for cancer treatment. Moreover, nurses need a better understanding regarding targeted therapies and immunotherapies to ameliorate outcomes in patients receiving these therapies, as well as management and early detection of possible adverse effects, especially adverse events associated with checkpoint inhibitors and various other therapies that control T-cell activation causing autoimmune toxicity. Nurses practice in numerous settings, such as hospitals, home healthcare agencies, radiation therapy facilities, ambulatory care clinics, and community agencies. Therefore, as compared to other members of the healthcare team, nurses often have better opportunities to develop the essential rapport in providing effective nurse-led patient education, which is important for effective therapeutic outcomes and continuance of therapy. In this article, we have particularly focused on providing a detailed overview on targeted therapies and immunotherapies used in cancer treatment, management of their associated adverse events, and the impact as well as strategies of nurse-led patient education.

The cancer nursing workforce in Australia: a national survey exploring determinants of job satisfaction

BACKGROUND

To maintain and improve the quality of the cancer nursing workforce, it is crucial to understand the factors that influence retention and job satisfaction. We aimed to investigate the characteristics of cancer nurses in Australia and identify predictors of job satisfaction.

METHODS

We analysed data from an anonymous cross-sectional survey distributed through the Cancer Nurses Society Australia membership and social media platforms from October 2021 to February 2022. The survey was compared to national nursing registration data. Data were analysed with non-parametric tests, and a stepwise, linear regression model was developed to best predict job satisfaction.

RESULTS

Responses were received from 930 cancer nurses. Most respondents (85%) described themselves as experienced nurses, and more than half had post-graduate qualifications. We identified individual, organizational, and systemic factors that contribute to job satisfaction and can impact in workforce shortages. The findings include strategies to address and prioritize workforce challenges. There were 89 different titles for advanced practice nursing roles. Managing high workload was a reported challenge by 88%. Intention to stay less than 10 years was reported by nearly 60%; this was significantly correlated with job satisfaction and age. Significantly higher scores for job satisfaction were associated with those who had career progression opportunities, career development opportunities, adequate peer support and a clearly defined scope of role. Conversely, job satisfaction scores decreased the more people agreed there was a lack of leadership and they had insufficient resources to provide quality care.

CONCLUSION

Cancer nurses are critical to the delivery of cancer care however, the workforce faces multiple challenges. This study provides an understanding of the Australian cancer nursing workforce characteristics, their roles and activities, and highlights important considerations for retaining nurses in the profession.

What are We Asking Patients to Do? A Critical Ethical Review of the Limits of Patient Self-Advocacy in the Oncology Setting

Increasing emphasis on patient self-management, including having patients advocate for their needs and priorities, is generally a good thing, but it is not always wanted or attainable by patients. The aim of this critical ethical review is to deepen the current discourse in patient self-advocacy by exposing various situations in which patients struggle to self-advocate. Using examples from oncology patient populations, we disambiguate different notions of self-advocacy and then present limits to the more demanding varieties (i.e., health-related, trust-based, and psychological); we argue that these limits create ethical dilemmas with respect to whether it is always desirable to encourage patients to self-advocate. We conclude that self-advocacy can be both under and overrated with respect to how much it benefits the patient with cancer, with many instances being indeterminate. Ultimately, providers must understand the patient's perspective relative to the challenges they are experiencing and work with them to meet their needs.

Quality of counselling assessed by patients after total knee arthroplasty: A cross-sectional study

Patient counselling is a key function in nursing. High-quality counselling promotes adherence to treatment and reduces complications. The purpose of the study was to describe the quality of counselling experienced by total knee arthroplasty patients following surgery. The study was a descriptive cross-sectional study. The data were collected from patients following total knee arthroplasty (N = 60) in 2016 with a modified Quality of Counselling Instrument, and analysed using statistical methods. Over half of the patients (58%) were women and the mean age was 68 years (range 49-84). Over a quarter of patients (28.9%) lived alone, and about two-thirds were overweight (42.1%), or obese (31.6%). After surgery, many patients (88%) experienced moderate pain. Half of patients (52.6%) received a good quality of counselling for the disease and its treatment, and counselling for recovery from treatment (81.6%) was good. Most patients (92.1%) received satisfactory counselling about physical activity. There was a correlation between the disease and its treatment counselling and quality of life (r = -0.553, p = 0.003) and pain (r = -0657, p = 0.000). Interaction during counselling was good (97.4%) and it was implemented in a patient-centred way (89.5%). High-quality counselling implemented in a patient-centred manner can play a part in reducing pain and increasing patients' quality of life.

The Effect of a Patient Education Multimodal Digital Platform on Knowledge Acquisition, Self-efficacy, and Patient Satisfaction

This study examined the impact of digital training instrument based on multimodal learning approach on surgical ward hospitalized patient education-related variables. The study was conducted as a multisite study in a large medical center as a two-arm, controlled trial with randomized cluster sampling. All patients meeting the inclusion criteria were offered the opportunity to participate. The control group (n = 40) received nurse explanation on home self-injection of enoxaparin sodium, whereas the intervention group (n = 40) received a tablet for multimodal learning specifically developed for this study. All participants completed before-and-after questionnaires evaluating knowledge acquisition, change in self-efficacy, and patient satisfaction. Results showed that the intervention group gained significantly more knowledge than the control group (P < .01). There was no significant difference in the level of self-efficacy change between the groups, and it was found that the control group patients were more satisfied with the training process (P = .01). This study shows that the use of a digital application for the benefit of patients' self-injection learning is effective in achieving educational goals such as knowledge acquisition and therefore can be a helpful resource for caregivers. Yet, these applications are not a substitute for attention provided by professionals, which is highly valued by patients.

Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of lung cancer and mesothelioma

Immunotherapy has transformed lung cancer care in recent years. In addition to providing durable responses and prolonged survival outcomes for a subset of patients with heavily pretreated non-small cell lung cancer (NSCLC), immune checkpoint inhibitors (ICIs)— either as monotherapy or in combination with other ICIs or chemotherapy—have demonstrated benefits in first-line therapy for advanced disease, the neoadjuvant and adjuvant settings, as well as in additional thoracic malignancies such as small-cell lung cancer (SCLC) and mesothelioma. Challenging questions remain, however, on topics including therapy selection, appropriate biomarker-based identification of patients who may derive benefit, the use of immunotherapy in special populations such as people with autoimmune disorders, and toxicity management. Patient and caregiver education and support for quality of life (QOL) is also important to attain maximal benefit with immunotherapy. To provide guidance to the oncology community on these and other important concerns, the Society for Immunotherapy of Cancer (SITC) convened a multidisciplinary panel of experts to develop a clinical practice guideline (CPG). This CPG represents an update to SITC’s 2018 publication on immunotherapy for the treatment of NSCLC, and is expanded to include recommendations on SCLC and mesothelioma. The Expert Panel drew on the published literature as well as their clinical experience to develop recommendations for healthcare professionals on these important aspects of immunotherapeutic treatment for lung cancer and mesothelioma, including diagnostic testing, treatment planning, immune-related adverse events, and patient QOL considerations. The evidence- and consensus-based recommendations in this CPG are intended to give guidance to cancer care providers using immunotherapy to treat patients with lung cancer or mesothelioma.

The COVID-19 patients' educational needs assessment questionnaire (COPENAQ): development and psychometrics

Background

Despite the importance of assessing COVID-19 patients' educational needs, there is currently no standard tool for a comprehensive assessment of these needs. The present study was aimed at developing a questionnaire to assess the educational needs of COVID-19 patients and determining its psychometric properties.

Methods

This study was conducted using an exploratory sequential mixed methods design in 3 stages. At the first stage, patients' educational needs were explained and determined using conventional content analysis so that a total of 15 COVID-19 patients were first selected using purposive sampling and then interviewed. At the second stage, the questionnaire items were developed using the qualitative findings and a review of valid sources related to the study subject. At the third stage, the psychometric properties of the questionnaire were determined using internal consistency reliability and the face, content, and construct validities.

Results

The mean content validity ratio and the content validity index were obtained to be 0.94 and 0.92, respectively. The internal consistency was evaluated using Cronbach's alpha, which was measured to be 0.97. Based on the exploratory factor analysis, the questionnaire was developed with 36 items in four subscales of "disease recognition and treatment follow-up", "prevention of infection transmission", "medication regimen", and "psychological and physiological needs". The results of confirmatory factor analysis also showed appropriateness and approval of the structural model obtained from the questionnaire.

Conclusion

This questionnaire was found to have the necessary psychometric criteria (validity and reliability) so that it can be applied to assess the educational needs of COVID-19 patients and provide better and more effective patient education for them.

Educational Theory and Cognitive Science: Practical Principles to Improve Patient Education

There can be multiple barriers to implementation of patient education, yet there are also multiple modalities and opportunities for engaging patients. Using frameworks and evidence from multiple disciplines can inform nursing design of patient education approaches. This article provides an introduction to educational theory and cognitive science principles such as constructivism, metacognition, deliberate practice, and cognitive load for consideration in improving the effectiveness and outcomes of patient education.

The principles and practices of psychoeducation with alcohol or other drug use disorders: A review and brief guide

OVERVIEW

In the current work, we build upon a small body of literature that delineates cross-cutting factors, or processes, of evidence-based alcohol or other drug (AOD) therapies. Here, we discuss Psychoeducation. We define psychoeducation as a brief process of therapy focused on the communication of varied aspects of disease- and/or treatment-related information.

METHOD

The authors conducted a literature review and qualitative content analysis to derive a set of principles and practices of psychoeducation. The review used source documents (i.e., literature reviews, therapy manuals, and government-issued practice guidelines) and videos (i.e., therapy demonstration videos), and we performed analyses in NVIVO.

RESULTS

The review identified nine principles and 21 practices. Together, the principles suggest that psychoeducation in evidence-based addictions therapies can be characterized as a collaborative approach to teaching, education, or other provision of information. The term collaborative denotes a shift in emphasis from compliance to a more egalitarian partnership focused on meeting individual health needs. Specific practices included ways to transition to psychoeducation (e.g., provide rationale and promote expectancy), teaching methods in psychoeducation (e.g., use plain language), tailoring content in psychoeducation (e.g., to learning style, to cultural worldview), and methods for facilitating a dialogue about the information (i.e., five question types), for facilitating understanding and retention of the information (e.g., tailor to individual needs, use of varied teaching modalities), and how to end psychoeducation and engage in related goal-setting, where applicable.

CONCLUSIONS

We frame psychoeducation as a collaborative approach to teaching where client engagement, understanding, and utilization of the information provided is the central goal. We offer a novel resource with pragmatic value to trainees, providers, and clinical supervisors who do not consider themselves aligned with a single evidence-based modality but who may benefit from training and proficiency assessment in core, behavioral health counseling competencies.

Untangling the Multidisciplinary Care Web: Streamlining Care Through an Immune-Related Adverse Events (IRAE) Tumor Board

Immune-related adverse events (IRAEs) are becoming increasingly common as the use of immune checkpoint inhibitors expands into more tumor types and treatment settings. Although the majority of IRAEs are mild and can be managed in the outpatient setting by the medical oncologist, severe IRAEs can be life threatening and often require complex care coordination among multiple providers. These providers include a variety of non-oncology specialists who have interest and expertise in managing IRAEs. Multiple systems-based solutions have been proposed in the literature, but these need to be tailored to the needs and resources of each practice setting. In this article, we highlight the challenges of IRAE care by presenting an illustrative case from our institution. We then describe the format and structure of the IRAE Tumor Board established at the University of Washington/Seattle Cancer Care Alliance/Fred Hutchinson Cancer Research Center. Finally, we discuss how this tumor board attempts to address clinical issues related to complex IRAE presentations and provide IRAE education.